Serving individuals in Pinellas County who are blind or visually impaired
Lighthouse of Pinellas
Patient Info:
Patient Name:
Date:
Patient Phone:
Referring Doctor:
Reason for Referral: Activities of Daily Living Counseling for Adjustment to Blindness Use of Low Vision Aids and Devices Orientation and Mobility Computer Access Technology Clinical Low Vision Evaluations – provided through an agreement with Dr. G. Timothy Petito at his private office located at 8695 – 4th Street N., St. Petersburg, Florida
Diagnosis:
Visual Acuity: OD:
OS:
Visual Field Impairment: